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Osteomyelitis
Definition
Osteomyelitis is a bone infection caused by bacteria or other germs.
Causes
Bone infection is most often caused by bacteria, but it can also be caused by fungi or other germs.
- Bacteria may spread to a bone from infected skin, muscles, or tendons next to the bone. This may occur under a skin sore.
- The infection can also start in another part of the body and spread to the bone through the blood.
- A bone infection can also start after bone surgery. This problem is more likely if the surgery is done after an injury or if metal rods or plates are placed in the bone.
In children, the long bones of the arms or legs are most often involved. In adults, the feet, spine bones (vertebrae), and hips (pelvis) are most commonly affected.
Risk factors are:
- Diabetes
- Hemodialysis
- Poor blood supply
- Recent injury
- Use of illegal injected drugs
People who have had their spleen removed are also at higher risk for osteomyelitis.
Symptoms
- Bone pain
- Fever
- General discomfort, uneasiness, or ill-feeling (malaise)
- Local swelling, redness, and warmth
Other symptoms that may occur with this disease:
- Chills
- Excessive sweating
- Low back pain
- Swelling of the ankles, feet, and legs
Exams and Tests
A physical exam shows bone tenderness and possibly swelling and redness.
Tests may include:
- Blood cultures
- Bone biopsy (which is then cultured)
- Bone scan
- Bone x-ray
- Complete blood count (CBC)
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR)
- MRI of the bone
- Needle aspiration of the area around affected bones
Treatment
The goal of treatment is to get rid of the infection and reduce damage to the bone and surrounding tissues.
Antibiotics are given to destroy the bacteria causing the infection.
- You may receive more than one antibiotic at a time.
- Often, the antibiotics are given through an IV (intravenously, meaning through a vein) rather than by mouth.
- Antibiotics are taken for at least 4 - 6 weeks, often through an IV at home.
Surgery may be needed to remove dead bone tissue if you have an infection that does not go away.
- If there are metal plates near the infection, they may need to be removed.
- The open space left by the removed bone tissue may be filled with bone graft or packing material. Doing this promotes the growth of new bone tissue.
Infection that occurs after joint replacement may need surgery to remove the replaced joint and infected tissue around the area. A new prosthesis may be implanted in the same operation. More often, doctors wait until the infection has gone away.
If you have diabetes, it will need to be well controlled. If there are problems with blood supply to the infected area, such as the foot, surgery to improve blood flow may be needed to treat the infection.
Outlook (Prognosis)
With treatment, the outcome for acute osteomyelitis is usually good.
The outlook is worse for those with long-term (chronic) osteomyelitis. Symptoms may come and go for years, even with surgery. Amputation may be needed, especially in those with diabetes or poor blood circulation.
The outlook for those with an infection of the prosthesis depends, in part, on:
- The patient's health
- The type of infection
- Whether the infected prosthesis can be safely removed
When to Contact a Medical Professional
Call your health care provider if:
- You develop symptoms of osteomyelitis
- You have osteomyelitis and the symptoms continue despite treatment
References
Matteson EL, Osmon DR. Infections of bursae, joints, and bones. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 280.
Berbari BF, Steckelberg JM, Osmon Dr. Osteomyelitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 103.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
